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NEURORADIOLOGY Table of Contents   
Year : 2009  |  Volume : 19  |  Issue : 2  |  Page : 148-150
Long-segment intramedullary spinal dermoid


1 Department of Radiodiagnosis, R.N.T. Medical College and Associated Group of Hospitals, Udaipur (Rajasthan) 313 001, India
2 MR Centre, M.B. Govt. Hospital, Udaipur (Rajasthan) - 313 001, India

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   Abstract 

A 30-year-old man presented with a fairly large intramedullary mass lesion involving virtually the entire spinal cord. It was hyperintense on both T1W and T2W sequences, with signal suppression on fat-saturation images. Subsequent noncontrast CT scan of the spine confirmed the presence of fat and calcification within the lesion, thus leading to the diagnosis of an intramedullary dermoid.

Keywords: Dermoid; intramedullary; spinal

How to cite this article:
Sharma N C, Chandra T, Sharma A, Bajaj M, Kundu R. Long-segment intramedullary spinal dermoid. Indian J Radiol Imaging 2009;19:148-50

How to cite this URL:
Sharma N C, Chandra T, Sharma A, Bajaj M, Kundu R. Long-segment intramedullary spinal dermoid. Indian J Radiol Imaging [serial online] 2009 [cited 2020 Aug 4];19:148-50. Available from: http://www.ijri.org/text.asp?2009/19/2/148/50840
Spinal dermoids are rare, benign, slow-growing tumors arising from more than one of three primitive germ cell layers. [1] They are intradural, and sometimes intramedullary, lesions. Imaging may demonstrate areas of fat and calcification within them. [2] We report a case of a long-segment intramedullary dermoid extending from the cervical region to the conus medullaris.


   Case Report Top


A 30-year-old male presented with pain in the right lower limb for 1 year. He also complained of difficulty in passing urine for 3 months. On examination, saddle anesthesia was noted, with grade 3 power in the left lower limb. MRI of the lumbosacral spine revealed a fairly large intramedullary mass lesion that appeared hyperintense on both T1W and T2W sequences, with signal suppression on fat-saturation images [Figure 1A],[Figure 1B] and [Figure 2A]. This lesion had three separate segments: one segment extended from the base of the skull to the D1 level, the second from D2 to D11, and the third segment from D11-D12 to L2, in the conus medullaris. The segments in the cervical region and the conus medullaris showed lobulated margins, with mild expansion of the cord and heterogeneous signals. Prominent flow voids were also seen in the cervical region. The segment in the dorsal region of the cord showed well-defined regular outlines and lay centrally in the intramedullary compartment. On the postcontrast study, there was mild heterogeneous enhancement of the mass lesion at the conus medullaris [Figure 2B],[Figure 2C]. These findings were suggestive of a fairly large fat-containing mass lesion, most likely an intramedullary dermoid. Subsequent noncontrast CT spine with sagittal reconstructions confirmed the presence of fat and calcification within the lesion [Figure 3A],[Figure 3B],[Figure 3C], thus supporting the diagnosis of an intramedullary dermoid. The patient refused surgery and therefore histopathological confirmation could not be obtained.


   Discussion Top


Dermoid tumors constitute 1.1% of intraspinal tumors. [3] They are thought to arise from the inclusion of ectopic embryonic rests of ectoderm within the spinal canal at the time of neural tube closure during embryonic development. [4] The lumbosacral region is the most common site to be affected (60%). [5]

Although dermoid tumors develop from the embryonic period, they are slow-growing lesions and do not cause symptoms till adult life. [3] Most dermoid tumors become clinically apparent during the second or third decade of life. [6] There is a slight male predominance.

They may be associated with other forms of dysraphism and in about 20% of cases, a dorsal dermal sinus can be seen. [1] Other associations include bony malformations and tethered cord. [7]

The combination of fluid, soft tissue, calcium, and fat is diagnostic of a dermoid tumor. Because of the varying amounts of soft tissue, fat, calcium, and hemorrhage, MRI typically demonstrates heterogeneous signal intensity. [1] The relatively high signal from fat on MRI, especially the bright signal on T1W images, makes identification of the lipid component easy. [7] This can be confirmed by demonstrating low attenuation (negative Hounsfield numbers) on a nonenhanced CT scan, as was done in our case.

Dermoid tumors may have two distinct portions: a lipid part and a more solid or more fluid part. In our case, the lipid component extended from the intramedullary portion of the cervical spinal cord to the thoracolumbar region, with the more solid portion of the tumor being seen in the region of the conus medullaris. The soft tissue component usually enhances after administration of intravenous contrast medium.

To the best of our knowledge, a long-segment intramedullary dermoid is extremely rare. In our patient, the intramedullary dermoid extended from the cervical spinal cord to the conus medullaris; such a case has not been reported before.

In conclusion, MRI is helpful in detecting intraspinal dermoid tumors and delineating their extent. CT plays an important complementary role in identifying areas of fat and calcification.

 
   References Top

1.McAdams HP, et al . Mediastinum. In: Haaga JR, editor. CT and MR imaging of the Whole Body. 4 th ed. Vol.1. p. 959-60.  Back to cited text no. 1    
2.Stevens JM, Rich PM. The imaging of spinal pathology. Grainger and Allison's Diagnostic radiology. 4 th ed. Vol 2. p. 2430.  Back to cited text no. 2    
3.Lunardi P, Missori P, Gagliardi FM, Fortuna A. Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors. Neurosurgery 1989;25:860-4.  Back to cited text no. 3    
4.Netsky MG. Epidermoid tumors: Review of the literature. Surg Neurol 1988;29:477-83.  Back to cited text no. 4    
5.Graham DV, Tampieri D, Villemure JG. Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging. Neurosurgery 1988;23:765-7.  Back to cited text no. 5    
6.John C. Egelhoff Pediatric Head and Neck Imaging. In: Haaga JR, editor. CT and MR imaging of the Whole Body. 4 th ed. Vol 1. p. 696.  Back to cited text no. 6    
7.Cha JG, Paik SH, Park JS, Park SJ, Kim DH, Lee HK. Ruptured spinal dermoid cyst with disseminated intracranial fat droplets. Br J Radiol 2006;79:167-9.  Back to cited text no. 7    

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Correspondence Address:
N C Sharma
D-12, M.B. Government Hospital Campus, Udaipur (Rajasthan)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.50840

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    Figures

  [Figure 1A], [Figure 1B], [Figure 2A], [Figure 2B], [Figure 2C], [Figure 3A], [Figure 3B], [Figure 3C]

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